Hip Changes in Asymptomatic Softball Pitchers

The Warden et al. (2025) Asymptomatic Female Softball Pitchers Have Altered Hip Morphology and Cartilage Composition study was to see whether softball pitchers develop changes in their hip bones and hip cartilage from years of pitching. The researchers studied female college softball pitchers and compared them to cross-country runners and non-athletic females. The study had two parts. In the first group, CT scans were used to examine hip bone shape in 25 softball pitchers and 13 runners. The researchers measured things like alpha angle, which is used to identify cam morphology (extra bone growth around the hip joint linked to femoroacetabular impingement, or FAI). In the second group, MRI scans were used to study cartilage health in 10 softball pitchers and 4 non-athletic controls. The MRI scans measured T1ρ and T2 relaxation times, which help detect early cartilage degeneration before arthritis develops. The researchers also measured glute muscle size and compared the drive leg and stride leg to see if the repeated asymmetrical loading of pitching caused side-to-side differences.

They found:

Hip Bone Shape (Cam Morphology)

• Softball pitchers had much larger alpha angles than runners

• Pitchers were 21 times more likely to have cam morphology (alpha angle ≥60°)

👉 Indicates altered hip bone structure in pitchers

Frequency of Cam Morphology

• 64% of pitchers had cam morphology in at least one hip

• 28% had cam morphology in both hips

• Overall:

  • 52% of pitcher hips showed cam morphology

Hip Cartilage Changes

• Pitchers had:

  • Higher T2 relaxation times

  • Higher T1ρ relaxation times in some regions

👉 These changes suggest:

• More water content

• Reduced cartilage quality

• Possible early cartilage degeneration

Areas Most Affected

• Greatest cartilage changes occurred in:

  • Superior femoral cartilage

  • Anterior femoral cartilage

  • Anterior acetabular cartilage

👉 These are common areas involved in FAI syndrome

Drive Leg vs. Stride Leg

• The drive leg showed:

  • Greater cartilage changes

  • Higher T1ρ and T2 values

• Surprisingly, the stride leg had:

  • Greater bone density

  • Larger glute muscles

👉 Suggests the drive leg may experience different types of stress than expected

Labral Tears & Cartilage Damage

• MRI showed:

  • 7 of 20 hips had labral tears

  • Some pitchers already had partial cartilage loss

• All athletes were still asymptomatic (no hip pain)

👉 Structural changes can exist before pain develops

Implications: The authors concluded that softball pitching may cause important long-term changes to the hips, even in athletes who do not currently feel pain. Pitchers had much higher rates of cam morphology and cartilage changes compared to runners and non-athletic controls, suggesting that the repeated loading from pitching affects hip structure over time. The findings also showed that cartilage changes may begin before athletes experience symptoms, which could eventually increase the risk of femoroacetabular impingement (FAI) and hip osteoarthritis later in life. One interesting finding was that the drive leg showed greater cartilage changes even though the stride leg experiences larger ground reaction forces and stronger muscles. This suggests that hip stress is not just related to force magnitude, but also to hip position, rotation, and repetitive movement patterns during pitching. The authors emphasized that more long-term research is needed to determine whether these structural changes eventually lead to pain, injury, or arthritis.

Key Takeaways

This paper strongly supports the idea that:

• Repetitive pitching loads change the body structurally

• Softball pitching affects:

  • Bone shape

  • Cartilage quality

  • Hip symmetry

It also connects to themes we have covered here, including:

• Kinetic-chain loading:

  • GRFs

  • stride vs drive leg loading

  • asymmetrical adaptations

  • kinetic chain efficiency

This paper provides evidence that:
👉 Long-term asymmetrical loading may physically remodel the hip joint itself.

Also…

Another podcast show that I have recommended before had another banger on this past week. The Elite Baseball Development Podcast with Eric Cressey had current MLB pitcher Slade Cecconi on to talk about preparation and how he approaches performance. He had some interesting insights on how he approaches pitch selection within an at bat. Cool stuff.

CHECK IT OUT!!!!

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